Chapter 6 – Health Apps for Diagnostics and Therapy

Die Nutzung von mobilen Anwendungen auf Smartphones und Tablet-Computern im Gesundheitswesen und damit in der Medizin hat stark zugenommen. Evidenznachweise für medizinische Apps gibt es nur wenige. Ihre Nutzen in Diagnostik und Therapie besteht darin, an jedem Ort und zu jeder Zeit ortsunabhängige beliebige Informationen zu erfassen, aufzurufen, zu visualisieren und damit auch Entscheidungen zu treffen. Apps zur Diagnostik werden vorwiegend von medizinischem Fachpersonal genutzt, Apps zur Therapie hingegen von ärztlichem Personal wie von Patientinnen und Patienten gleichermaßen verwendet. Therapien können durch den Einsatz von Apps weiter optimiert werden, etwa durch gewonnene Mobilität oder durch geringere Kosten. Apps im Bereich Selbstmanagement, wie das Führen von Patiententagebüchern oder Apps, die an die Einnahme von Medikamenten erinnern, sind sinnvoll. Ähnlich sind Apps zu bewerten, die zu gesundheitsbewussten Verhalten anregen, etwa Trainingspläne für körperliche Übungen oder Ernährungstagebücher für die gesunde Ernährung. Tragbare Geräte wie Uhren, Brillen, Arm- und Körperbänder stellen eine unauffällige Lösung zur Überwachung von Vitalfunktion dar. Wearables können Nutzerinnen und Nutzern durch zusätzliche Funktionen somit Unterstützung bei der Erhaltung oder Verbesserung der Gesundheit bieten, sind jedoch teils mit hohen Kosten verbunden. Ärztinnen und Ärzten bieten die mobilen Anwendungen insbesondere bei erkrankten Patientinnen und Patienten Möglichkeiten, aktuelle Informationen über die Vitaldaten oder die derzeitige Situation der Betroffenen zu erhalten. Für Patientinnen und Patienten ist es einfach komfortabel, unabhängig von Zeit und Ort mit dem Arzt kommunizieren zu können. Die Betrachtung der Grenzen von Apps zeigt auf, dass eine Reihe von Barrieren und Herausforderungen vor dem nutzbringenden Einsatz dieser Tools stehen. Grundsätzlich bieten Apps die Chance zur Partizipation und Patientenbeteiligung und unterstützen in verschiedenen Phasen der Versorgungsprozesse im Gesundheitswesen.The use of mobile applications that are installed on smartphones and tablet computers has greatly increased in healthcare in general and thus also in medicine. However, scientific evidence with respect to the effectiveness of medical apps is still lacking. The possibility to diagnose and treat, in any place and at any time, to capture, access, visualize information and thus to come to decisions regardless of location, holds great promise, as do the rapid ways of transmitting medical data made possible by mobile technology. This is an essential aspect for modern aspects of telemedicine. Apps for diagnostics are primarily used by health care professionals, whereas apps with a therapeutic focus are used by both doctors and patients alike. Therapies can be further optimized by the use of apps, e.g. by providing mobility or through lower health care costs. Patient diaries or apps that instruct patients in the proper use of medication are helpful in patient self-management. So are apps that encourage health-conscious behavior, such as training plans for physical exercises or nutrition diaries for healthy eating. Portable devices such as watches, eyewear, and arm and body belts provide unobtrusive monitoring of vital function. Wearables equip users with additional functions that promote health. The downside lies in their high costs. Via mobile applications, doctors can receive and review up-to date information, e.g. vital signs or data about the patients' current situation. For patients, the added comfort of being able to communicate with their doctor regardless of time and place is a benefit. The evaluation of the limitations of apps shows that a number of barriers and challenges need to be overcome to take advantage of the beneficial aspects of these tools. In summary, apps offer the chance to involve patients actively in the management of their health and to support patients and doctors in various stages of the health care process

Chapter 5 – Health Apps in Prevention

Die gesundheitliche Prävention hat einen hohen Stellenwert in der Öffentlichkeit und erfährt durch Apps eine große individuelle Aufmerksamkeit. Ihre Anwendung bzw. der Nutzen in der Prävention besteht darin, Menschen einen niedrigschwelligen Zugang zu gesundheitsfördernden Angeboten zu verschaffen. Gesundheits-Apps in der Primärprävention werden vorwiegend für Laien konzipiert, nur wenige für medizinisches Personal. Die meisten Studien befassen sich mit dem Themenbereich Lifestyle (Fitness und körperliche Aktivität, Ernährung und Gewicht, Suchtverhalten), und auch die Studien, die sich mit der Wirkung von Apps in der Prävention von spezifischen Erkrankungen auseinandersetzen, erfassen überwiegend Surrogatparameter und keine krankheitsspezifischen Outcomes. Inwiefern Apps einen positiven Einfluss auf den Rückgang von Risikofaktoren bei kardiovaskulären Erkrankungen oder in der Prävention von Krebs haben, ist nicht eindeutig geklärt, zumal die Endpunkte auch in der Präventionsdiskussion nicht eineindeutig festgelegt sind. Erste erfreuliche Auswirkungen bei der Nutzung von Apps zeigen sich in Bezug auf die Zunahme körperlicher Aktivität und eine Anpassung der Ernährung bzw. der Gewichtskontrolle. Gegenüber Printmedien stellen Apps eine schnellere Anpassungsmöglichkeit an neue Informationen dar, und sie bieten somit die Möglichkeit, immer aufgrund der aktuellen Datenlage Empfehlungen auszusprechen. Wissenschaftliche Langzeitstudien, welche Anforderungen Gesundheits-Apps erfüllten sollten, um einen wirkungsvollen Beitrag zur Prävention zu leisten, liegen aktuell nicht vor. Hier sind vergleichende Studien zur Untersuchung des mittel- und langfristigen Einflusses der Nutzung von Apps auf das Gesundheitsverhalten und damit auf Risikofaktoren erforderlich, insbesondere bezogen auf gesundheitlich vulnerablen Bevölkerungsgruppen. Angesichts der sich rasant entwickelnden Technologie sind dabei nicht nur die aktuell etablierten wissenshaften Standards anzulegen, sondern auch neue, qualitätsgesicherte Methoden zu entwickeln.Preventive health care has a high public priority and receives increasing individual attention in the population based on their established use of apps. The benefit of prevention is to provide a low-threshold access to health-promoting services. Apps in primary prevention are primarily designed for lay people, only a few are provided for medical staff. Most studies focus on the topic of lifestyle (fitness and physical activity, diet and weight, addictive behavior). Studies that deal with the effect of apps in the prevention of specific diseases predominantly deal with surrogate parameters but not disease-specific outcomes. It is unclear to what extent apps have a positive impact on the reduction of risk factors for cardiovascular disease or in the prevention of cancer, particularly since the end points are not clearly defined within the prevention debate. First encouraging effects with respect to the use of apps have been shown in relation increased physical activity, and an adaptation of nutrition and weight control. In contrast to print media, apps can rapidly integrate new information and knowledge. Thus, they are able to quickly adapt their recommendations to the available information as well as recorded data. Scientific long-term studies about the specific requirements apps need to fulfill to be able to show an effect for prevention are currently unavailable. In this context, comparative studies are needed that point out the necessary medium- and long-term impact of the use of apps on health behavior and thus on risk factors, particularly in vulnerable healthcare populations. In the face of a rapidly developing technology, new standards are warranted to establish quality-assured methods

Expectations of new technologies in nursing care among hospital patients in Germany – an interview study

IntroductionNew technologies will be increasingly available for nursing care, including robots, patient mobilisation devices, digital event detection or prevention equipment. Technologies are expected to support nurses, increase patients’ safety and reduce costs. Yet, although these technologies will significantly shape patients’ experience, we need to learn more about patients’ perspectives regarding new technology in care. This study aims to investigate attitudes, expectations, worries and anticipated implementation effects of new assistive technology in nursing care by patients.MethodsQualitative, guided, semi-open interviews were conducted. The recruitment was carried out in a trauma surgery ward of a university hospital in Germany. Eight different technologies were presented via video clips and additional information to the patients, followed by in-depth discussions. The interviews were analysed using qualitative evaluative content analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist was used to ensure study quality.ResultsStudy participants anticipate different outcomes for the implementation of new nursing technology: (1) For patients, they consider the potential for improvement in health and well-being as well as for their hospital stay experience, but also fear possible health risks or social or emotional factors like loss of autonomy or loneliness. (2) For professional nurses, participants expect relief from physically stressful work routines; however, they might be replaced by machines and lose their employment (3) For the nursing process, safety and quality improvements for care delivery may encounter a negative quantification of human life and risks of constant surveillance.ConclusionPatients identify opportunities, challenges and shortcomings of nursing technology implementation. They describe nuanced and mixed accounts of patients’ perspectives that are structured in a ‘continuum of anticipated effects’ of implementing technology in our article. The results can inform future implementation strategies

a qualitative study

Objectives: It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents’ lives with an increased risk for non- adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. Setting: In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. Results: This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. Conclusions: While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. Trial registration number: ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II)

Strategiepapier #2 zu den Empfehlungen des Nationalen Aktionsplans. Gesundheitskompetenz in die Versorgung von Menschen mit chronischer Erkrankung integrieren

Schaeffer D, Schmidt-Kaehler S, Dierks M-L, Ewers M, Vogt D. Strategiepapier #2 zu den Empfehlungen des Nationalen Aktionsplans. Gesundheitskompetenz in die Versorgung von Menschen mit chronischer Erkrankung integrieren. Berlin: Nationaler Aktionsplan Gesundheitskompetenz; 2019

How do health professionals translate evidence on early childhood allergy prevention into health literacy-responsive practice? A protocol for a mixed-method study on the views of German health professionals

Introduction Paediatricians, general practitioners (GPs) and midwives in primary care are important sources of information for parents on early childhood allergy prevention (ECAP). Research has shown that preventive counselling by health professionals can be effective in improving patients’ health literacy (HL) and health behaviour. Providing effective advice relies on two factors. First, health professionals need be up-to-date with research evidence on ECAP, to consider popular misconceptions and fears and to translate this knowledge into clear recommendations for parents (knowledge translation). Second, they need to know and apply counselling techniques and create a practice setting which accommodates parental HL needs (health literacy-responsive care). The objective of this study is to explore and assess how German health professionals take up and translate ECAP evidence into appropriate recommendations for parents, how they consider HL in counselling and practice organisation and what barriers and enablers they find in their performance of HL-responsive ECAP. Methods and analysis The study has a sequential mixed-method design, in two phases. In the first phase, qualitative semi-structured expert interviews will be conducted with health professionals (paediatricians, GPs and midwives) at primary care level and professional policy level. Data collection is ongoing until January 2022. In the second phase, based on the qualitative results, a standardised questionnaire will be developed, and pilot-tested in a wider population of German health professionals. The findings of both phases will be integrated. Ethics and dissemination The study has received ethical approval from the Ethics Committee of the University of Regensburg (18-1205-101). The results will be published in international peer-reviewed open access journals and via presentations at scientific conferences. The results will also be shared with German health professionals, decision-makers and potential funders of interventions

How do parents access, appraise, and apply health information on early childhood allergy prevention? A focus group and interview study

BackgroundWhen parents want to make health-related decisions for their child, they need to be able to handle health information from a potentially endless range of sources. Early childhood allergy prevention (ECAP) is a good example: recommendations have shifted from allergen avoidance to early introduction of allergenic foods. We investigated how parents of children under 3 years old access, appraise and apply health information about ECAP, and their respective needs and preferences.MethodsWe conducted 23 focus groups and 24 interviews with 114 parents of children with varied risk for allergies. The recruitment strategy and a topic guide were co-designed with the target group and professionals from public health, education, and medicine. Data were mostly collected via video calls, recorded and then transcribed verbatim. Content analysis according to Kuckartz was performed using MAXQDA and findings are presented as a descriptive overview.ResultsParents most frequently referred to family members, friends, and other parents as sources of ECAP information, as well as healthcare professionals (HCPs), particularly pediatricians. Parents said that they exchanged experiences and practices with their peers, while relying on HCPs for guidance on decision-making. When searching for information online, they infrequently recalled the sources used and were rarely aware of providers of “good” health information. While parents often reported trying to identify the authors of information to appraise its reliability, they said they did not undertake more comprehensive information quality checks. The choice and presentation of ECAP information was frequently criticized by all parent groups; in particular, parents of at-risk children or with a manifested allergy were often dissatisfied with HCP consultations, and hence did not straightforwardly apply advice. Though many trusted their HCPs, parents often reported taking preventive measures based on their own intuition.ConclusionOne suggestion to react upon the many criticisms expressed by parents regarding who and how provides ECAP information is to integrate central ECAP recommendations into regular child care counseling by HCPs—provided that feasible ways for doing so are identified. This would assist disease prevention, as parents without specific concerns are often unaware of the ECAP dimension of issues such as nutrition

The federal government commissioner for patient issues in Germany: initial analysis of the user inquiries

BACKGROUND: The political objective in many countries worldwide is to give better consideration to the interests of patients within the health system. The establishment of a federal government commissioner for the issues of patients in the health system in Germany in 2004 is part of these endeavours. The structure and field of activities of this institution has been unique so far. This study investigates for the first time the inquiries the commissioner receives from the public. METHODS: A 33% sampling (n = 850) of the written inquiries (correspondence and e-mails) addressed to the commissioner in the first six months of the year 2005 (n = 2580) was investigated. In a procedure comprising combined qualitative and quantitative levels, the material was thematically encoded and the inquiries allocated to the resulting categories (multiple nominations). The results are presented in descriptive form and investigated especially with respect to sex and age-specific differences. The interdependences between the categorized criteria are analysed. RESULTS: The inquirers are equally spread out amongst the sexes (49% women, 51% men). Older persons outweigh the younger (69% over 60 years). In most cases the issues take the form of claims (72%, n = 609). In every fifth inquiry (n = 168) the personal financial burden for health services is considered as being too high; about equally high (n = 159) is the proportion of persons who criticize the communication with health professionals, especially hospitals and doctors' surgeries. Every third who mentions a medical practice uses terms such as "uncertainty" and "anxiety". It is conspicuous that men more often than women write that they feel unfairly treated in the health system (62% vs. 38%, p < 0.05). CONCLUSION: Predominantly older persons seek the assistance of the federal government commissioner for patient issues. Considerable uncertainty and anxiety with respect to services and charges within the system of the German health insurances become evident. It is not possible from the data to draw conclusions concerning the impact of the commissioner's work on the health system. Nor do we gain any knowledge about the usefulness of the service for the individual. Therefore, evaluation of the political impact and the user satisfaction should follow